Pharmacology Drug Research Assignment

Cassidy Faulkner

Practical Nursing Program Okanagan College

PNSG 214 Pharmacology

Chiara Pinese

May 1, 2024

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 PNSG 214 – Pharmacology Research Assignment

Purpose: The knowledge of pharmacology is an important necessity for the prevention and treatment of diseases. This case Based
learning assignment involves problem-based learning and promotes the development of analytical skills.

Instructions:

Read the following case study and the information about George’s ‘Known Health Problems’ and the ‘Current Medications’
to answer the questions. Use your textbooks as resources.

Your answers and the reference list must be submitted in APA format. This should include a title page and a reference page.
Include your Rubric with the assignment. Use the tables provided for your Answers for Part A of the assignment .

Case Study “George”

George is an 85 year old client of Aboriginal decent and a new resident living at the facility where you are working as an LPN
Student. He was admitted to the facility 3 months ago and is comfortably settling in. A patient conference is being planned for
next week with the multidisciplinary team to discuss George’s care, treatments, and medications. As an LPN student, assigned
to George, one of your responsibilities is to assess George and gather information regarding his medication profile for review
by the team for this conference.

Known Health Problems: Type II diabetes mellitus, congestive heart failure, angina, past history of clot formation with venous
thrombosis. He also suffers from benign prostatic hyperplasia which causes him to have problems with dribbling and occasional
urinary retention. Recently he was diagnosed with glaucoma which he was ordered eye drops to treat.

• Medications List: Digoxin 0.125mg po daily ; Lasix 40mg po daily ; Metformin 500 mg BID; Glyburide 10mg BID
Finasteride 5mg Daily; Flomax 0.4mg Daily; Nitro dur patch 0.4g/hr daily in am; Timoptic 0.5% 1 gtt both eyes twice a
day ; Warfarin 5mg daily (based on INR bloodwork)

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 214A Case Study Rubric

Student name: Cassidy Faulkner

Question Comments / Grade

Part A: Question 1 Refer to table. Indicates corrects drug(s)
Drug profile for each condition (2 mark) /36
Accurately describes reason why, nursing
consideration and 2 pt teaching related to
George (2 mark for each description)
Part B: Question 2 Demonstrates knowledge of the /2
Drug assessment evaluation of the drug?

Question 3 Demonstrates knowledge of drug related /2

Drug evaluation to drug evaluation and provides rational.

Question 4 Demonstrates knowledge of condition

Condition and nursing intervention. 1 mark for /4
condition and 3 marks for
interventions
Question 5 Demonstrates knowledge related to /2
High alter assessment of High Alert Medications
medication
Question 6 Demonstrates knowledge related to side /3
Side effect effect of medication(s), nursing
intervention and safety of George.
Accurately list medication(s)
Question 7 Demonstrates knowledge of drug related /3
Drug administration to drug administration. 1 mark for
position. 2 marks for steps.
Question 8 Identifies four strategies in providing /2
Culturally safe care a culturally safe environment.

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Question 9 Identifies two examples /2
Interprofessional interprofessional roles (1 mark).
roles Provides description of professional
role and contribution to Georges’ plan
of care (1 mark).
APA Format Title page /4
reference in text
Reference page
Total marks /30 /60
Bonus mark Submitted Drug cards for assignment /1

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Part A: Use the table provided to submit your answers for Part 1.

1- Medication Profile: Using the table provided, list the drug names, drug classifications, mechanism of action and safe dose
range for each medication that George is taking. Include the reason George is taking each medication and list the
significant side effects and potential adverse reactions. Carefully review (the priority nursing considerations for each
medication. Include 2 patient/ family teaching priorities for George. (4 marks for each medication)

Part B: Answer the following questions using short answer format. Ensure answers are clear and concise.

2. You are planning to give George his medications and proceed to review the usual dosage, route, and frequency of his
Lasix Order. Consider drug contraindications. Are there any situations that you would not administer the drug? When is
the best time to administer Lasix? Why? (2 marks)

Due to Georges health conditions, I need to critically think about any downfalls of administering Lasix to George. Lasix can

contribute to high blood sugar levels for diabetics. Since George is a type 2 diabetic, I would provide patient teaching to him

regarding the signs and symptoms of hyperglycemia (Visovsky, 2022). Before I give Lasix to George, I would also assess his vital

signs, hydration status and monitor his daily weights. In situations where any of these are concerning to me, I would assess George

further and hold the medication while getting in contact with the physician. It is crucial that his potassium levels are monitored, if

the levels are not in the range of 3.5-5 mEq/L I would contact the physician before administering Lasix to George. The best time to

administer Lasix is in the morning to avoid sleep disturbances. This loop diuretic increases urine output so administering it in the

evening is not ideal because the patient may experience nocturia, and this will interrupt their sleep. As I would be the LPN, before

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 administering Lasix to George in the morning, I would educate him on the fact that he may experience increased urination if he is

not aware of this. Also encouraging him to be close to a bathroom due to this (Visovsky, 2022).

3. Following the administration of Lasix , your assessment of George includes the evaluation of the drug and it’s
therapeutic effect. List 4 ways that would indicate that his Lasix is effective? (2 marks)

George is on Lasix to manage his congestive heart failure (CHF) but how can Lasix help George with his CHF? We can see
therapeutic affects of his medication by:

• Decreasing edema caused by congestive heart failure. Once Lasix sets in George’s system, we will see decreased edema on his
body.
• Increased urination. George has BPH which results in him retaining urine. If he was not on Lasix, he most definitely has a
higher chance of enduring a UTI (Visovsky, 2022).
• Hypertension may be a clinical manifestation of CHF. To avoid the heavy workload the heart takes on when it is dealing with
failure, Lasix will contribute to lowering blood pressure by the body excreting excess fluids (Lewis’s 2020). As a result, you
may see George’s blood pressure decreasing.
• Due to the fluid retention CHF may cause, Lasix increases the excretion of the fluid which can affect George’s weight. We can
see therapeutic affect of Georges weight and abdominal girth decreasing (Vallerand, Sanoski, 2023).

4. If George were to show symptoms such as confusion, sweating, headache, shakiness, with skin: pale and cool to the
touch, what would this be a sign of? What are the priority nursing interventions and why? (1 mark for condition and 3
marks for intervention)

Based on these signs and symptoms, this indicates hypoglycemia. I would check George’s blood glucose levels first then if the

levels are below his normal blood glucose range, I would then encourage George to have a snack to raise his blood sugar. I would

refer to the PPO and IHA hypoglycemia protocol and have George have a snack containing sugar or have him ingest the appropriate

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amount of glucose tablets. I would check if George took his Metformin that day as well to investigate why the hypoglycemia episode

occurred. After George has a snack or glucose tablets, I would then check his blood sugar again afterwards. Once his blood sugars are

stable, I will assess George’s overall well-being and if needed, provide patient education on hypoglycemia and how to avoid it.

5. Warfarin is a High Alert Medication with a number of serious side effects. Carefully consider the role of the nurse in
anticoagulant therapy. Prior to giving George his Warfarin, briefly outline your priority assessments. (2 marks)

Warfarin is an anticoagulant that can help George avoid enduring another venous thrombosis. Vitamin K plays a major role in clot

formation so Warfarin will prevent Vitamin K from occurring in the intestinal tract. As the role of the nurse, my priority assessment is

to check his INR and PT levels (Visovsky, 2022). INR is a lab test that is required to be monitored when a patient is on Warfarin. INR

will display how long it takes for a patient’s blood to clot. The next priority assessment is observing for any signs of bleeding in

George. Since Warfarin can increase the risk for bleeding it is important we look for signs like bruising, bleeding of the gums,

nosebleeds, black tarry stool, hemorrhage, or nosebleeds. Other assessments that are important to be done before administering

Warfarin to George is taking his vital signs, toxicity or overdose of Warfarin and check if he is on any medications that may interact

with Warfarin.

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 6. Orthostatic Hypotension is a common side effect of many medications. Briefly describe the cause of this effect. Are there
any medications that George is taking that could cause orthostatic Hypotension? If so, which ones? Briefly describe
what nursing interventions that could be applied to ensure he is safe. (3 marks)

Orthostatic hypotension occurs when an individual experiences a drop in blood pressure when they enter an upright position. The heart

rate then increases to make up for the decrease in cardiac output (Potter & Perry, 2024). The individual may experience dizziness,

weakness, or faint. The medications George is on that may contribute to orthostatic hypotension is Digoxin, Flomax, Nitro dur patch

and Lasix. Nursing interventions for orthostatic hypotension is assisting the patient into an upright position, implementing non-slip

mats or socks, education patient on fall prevention and add more assistive mobility devices to George’s environment.

7. George has recently been diagnosed with Glaucoma. You are reviewing his order for eye drops and planning any special
techniques and equipment needs prior to administration. Proper administration lessens the danger of the drug being
absorbed systemically. What is the best way to position George to instill his eye drops? What steps do you take to
administer the drops correctly? (3 marks)

The best way to position George for his eyedrops to avoid any lost medication is to have him in a lay supine or, if he is sitting in a

chair, have him position his head back slightly. I would perform my 3 checks of this medication and keep in check with the 10 rights

of medication administration and provide patient teaching regarding this medication, making sure I include side effects. Ensure

George is looking at the ceiling. Before instilling his eye drops, I will clean any crusts or drainage from his eye with a warm cloth. My

next step is to have a tissue gently placed below George’s eye while my left hand is holding the tissue in place. I would instill the

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prescribed amount of Timoptic above his eye into the conjunctival sac. Once the drops are administered, I will place light pressure to

Georges nasolacrimal duct for 30-60 seconds. I will assess George for any side effects (Potter & Perry, 2024).

8. Identify four strategies how you could encourage and engage a culturally safe environment with George? (2 marks)

Since George moved into his new home (LTC) 2 months ago, it is important to implement an environment for George to feel safe

and free from any discrimination and racism. Due to the long history of racism in healthcare in Canada, I imagine it can be extremely

difficult for indigenous peoples to feel safe and gain trust in new healthcare settings. A culturally safe approach to George’s care is to

understand and acknowledge Georges family’s role in his care (CLRI, 2017). Indigenous families may incorporate and support George

in his care by having drumming and smudging ceremonies or utilizing traditional healing practices. Being aware of this can help the

nurse fully culturally support George and his family in his new home.

Take the opportunity to utilize any culturally competency modules or workshops the facility provides. Expanding your knowledge

on cultural safety and competency can avoid the risk of re-traumatization and education on indigenous people’s languages and

traditional practices. Reflect on your own beliefs, values, and views. If I may have negative views that may not promote George’s

safety of his cultural, its important to be aware of that and avoid implementing them into my practice. Striving towards a therapeutic

nurse-patient relationship with George can encourage a culturally safe environment. Understanding his cultural background and

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beliefs can help me cater to those preferences and avoid any triggers. It is important to acknowledge that George may have a difficult

time establishing trust with healthcare providers.

9. Interprofessional and collaborative approaches are important for promoting both individualized and holistic care.
Consider how the LPN could facilitate interprofessional involvement for George. Provide 2 specific examples (one
example must be related to his culture) and include a brief description of each professional role and how each team
member may positively contribute to Georges’ plan of care. (2 marks)

Indigenous patient navigators are wonderful resources for supporting indigenous peoples in their journey of care. They can provide

emotional and cultural assistance and offer multiple positive supports. I think this can benefit George to enhance his care in a safe

cultural sense. Another role is a social worker. I dove into some research regarding how social workers can support indigenous

peoples and their culture. They can acknowledge cultural care in the healthcare setting and refer indigenous peoples to cultural and

spiritual services. I believe this would positively benefit George because it can help him branch out to further services to support his

cultural and spiritual needs in his facility. If George speaks a certain language, a social worker can be a wonderful resource. Other

interprofessional approaches can be healthcare aides and nurses to support his daily care needs.

a.

PNSG 214: Pharmacology Research Assignment

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 Part A: Question 1: Medication Profile: Using the table provided, list the drug names and drug classifications, and side effects for
each medication that George is taking. Carefully consider the priority nursing considerations for each medication. Include 2 patient/
family teaching points for George. (4 marks for each medication)

Medication Classification Significant Review the Nursing Considerations/ implications for each
Name (Pharmacologic and Safe dose Range: Side Effects/Adverse drug. List 2 Priority patient/ family teaching
(generic & Therapeutic) (0.5 mark) reactions Points for “George”.
trade) (0.5 mark) (0.5 mark) (2 marks)
(0.5 mark)
Generic: Therapeutic: Geriatric: Daily Bradycardia 1. Educate George on how to take his pulse and have
digoxin Antiarrhythmics dose should not ECG changes George report his pulse to a health care professional if
Trade: Pharmacologic: surpass 0.125 mg Heart block pulse is <60 or >100
Lanoxin Digitalis glycosides Adult: Blurred vision
Anorexia 2. Ensure client is educated on the risk of fall associated
High alert Nausea with this medication and taught fall prevention
medication Vomiting strategies.
Beer’s alert Diarrhea
Pg. 447 DDG Fatigue
Headache Nursing considerations: Take apical pulse for 1 minute before
Adverse administering digoxin.
Arrhythmias
Generic: Therapeutic: Edema: Hypotension 1. As this is a loop diuretic, it will increase urine output so
furosemide diuretics PO (Adult): 20- Photosensitivity expressing the importance of George monitoring his
Trade: Lasix Pharmacologic: 80 mg/day as a Hearing loss fluid intake is essential. This medication also puts
Loop diuretics single dose Hyperglycemia George at risk for electrolyte imbalances. Educating
Beer’s drug Dehydration George on the signs and symptoms of dehydration or
Pg. 620 DDG Hypokalemia electrolyte imbalances is crucial. Advise him to contact
Hypomagnesemia their healthcare provider if he sees signs.
Increase liver enzymes
Constipation 2. Educate George about how he may experience an
Muscle cramps increase in blood glucose levels. Explaining George on
Adverse: the signs and symptoms of hyperglycemia is crucial.

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 Agranulocytosis Also advise George to report to his healthcare provider if
Aplastic anemia he does experience symptoms of this.
Erythema multiforme
Stevens-Johnson
Syndrome
Toxic epidermal
necrolysis
Generic: Therapeutic: PO (Adults): Abdominal bloating 1. Empathize with George that this medication will not
Metformin Antidiabetics Immediate- Diarrhea cure his type 2 diabetes but it will help control
Trade: Pharmacologic: release tablets: Nausea hyperglycemia.
Glucophage Biguanides 500 mg twice Vomiting
daily Unpleasant metallic taste 2. Educate George on the side effects of lactic acidosis and
Pg. 851 DDG *Maintenance of Decreased b12 levels the symptoms of it. This side effect involves lactic acid
blood glucose* Can be Adverse: buildup in the bloodstream which can lead to muscle and
increased at 500 Lactic acidosis abdominal pain, irregular heartbeat, and respiratory
mg at weekly distress. Advise George to report these symptoms to his
intervals up to healthcare provider.
2000 mg/day
Nursing intervention: Administer with meals to avoid
gastrointestinal irritation.
Generic: Therapeutic: PO (Adults): Photosensitivity 1. As this medication does stimulate the production of
Glyburide Antidiabetics Non-micronized: Hypoglycemia insulin from the pancreas, George is at risk of
Trade: Pharmacologic: 2.5-5 mg once Weight gain experiencing hypoglycemia. Review the signs and
Glynase Sulfonylureas daily Constipation symptoms of hypoglycemia with George. Advise George
Micronized: 1.5 Cramps to take the appropriate amount of glucose and have him
High Alert *Stimulates insulin – 3 mg/day Dizziness contact his healthcare provider.
Medication release from the Drowsiness 2. This drug can interact with diuretics and since George is
Beers drug pancreas to lower PO Geriatric: Headache on furosemide, educate him on the potential negative
blood sugars* Non-micronized: Weakness outcomes of this. George may express lack of effect with
Pg. 1182 DDG 1.25 – 2.5 Adverse: the drug due to the interactions.
mg/day Erythema multiforme 3. Educate George on the importance of reporting any
Micronized: 0.75 Aplastic anemia unusual weight gain, swelling in ankles and shortness of
– 3 mg/day breath to healthcare provider.

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Generic: Therapeutic: Benign prostatic Gynecomastia 1. There is a high risk of high-grade prostate cancer with
Finasteride Benign prostatic hypertrophy: Decreased libido, volume this drug. It is important to emphasize to George to
Trade: hyperplasia bph PO (Adults) – of ejaculate and erectile attend routine doctor checks up to ensure the condition
Propecia, agents Proscar: 5 mg dysfunction. of his prostate has not worsened and that there is no
Proscar Hair regrowth once daily Adverse: cancer present.
stimulants Prostate Cancer (High- 2. If symptoms have been improved or no longer present,
Pg. 858 DDG Pharmacologic: grade) keep continuously taking the medication as directed.
Androgen inhibitors Angioedema 3. Instruct George to report pain in his testicles at any
Breast cancer point when taking this medication (Visovsky, 2021)
*BPH reduces size of
prostate*
Generic: Therapeutic: PO (Adults): Dizziness 1. If symptoms are no longer present of an enlarged
Tamsulosin Benign prostatic 0.4 mg once Headache prostate, ensure George understands to take this
Trade: hyperplasia bph everyday after Orthostatic hypotension medication as directed and do not stop if no symptoms
Flomax agents meals Intraoperative floppy iris appear.
Pharmacologic: syndrome 2. Flomax can contribute to orthostatic hypotension. It is
Pg. 1198 Peripherally acting Rhinitis important to inform George to change positions slowly
antiadrenergic Alpha Priapism to reduce the effects of orthostatic hypotension.
adrenergic blockers Retrograde/diminished 3. This medication can result in abnormal ejaculation and
ejaculation ejaculation failure. Make George aware to reduce any
*Decreases anxiety.
contractions in smooth
muscle of the prostatic
capsule*
Generic: Therapeutic: Ophthalmic Temporary vision blurring 1. Systemic absorption may occur due to these eye drops.
Timolol Anti-Glaucoma agent adults: Reduce tear production. Education George on the effects that may occur from
Trade: Pharmacologic: 1 drop of 0.25 – Dry, red, and itchy eyes this as in possible results of bradycardia and
Timoptic Beta-adrenergic 0.5% solution 1- Adverse: hypotension. Have George close his eyes for 2-3 minutes
antagonists 2 times daily Decreased HR, BP, and to reduce the risk of systemic effects.
Pg. 1412 risk of heart failure. 2. Timolol can possibly hide or mask the symptoms of
Conjunctivitis hypoglycemia. It is crucial to educate George on this and
recheck his blood glucose levels regularly (Visovsky,
2021)

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Generic: Therapeutic: PO (Adults): Cramps 1. Anticoagulants increase the risk of bleeding. It is vital
Warfarin Anticoagulants 2-5 mg per day Nausea George is informed of the signs and symptoms of
Trade: Pharmacologic: for 2-4 days. Fever bleeding which can look like abnormal bruising,
Coumadin Coumarins Adjust the daily Adverse: bleeding gums, nosebleeds, black tarry stools and
dose based on Calciphylaxis hematuria.
Pg. 1325 DDG *Interferes with the INR results. Bleeding 2. George should be aware of the importance of avoiding
production and action any excessive consumption of Vitamin K. Consuming
High Alert of Vitamin K* too much of this vitamin can result in decreased
Medication therapeutic affects of Warfarin.
Beer’s drug
Generic: Therapeutic: Transdermal Hypotension 1. Nitro-dur is used for long-acting effects which can
Nitroglycerin Antianginals (Adults): 0.2 – Tachycardia prevent angina. Educate George to report any symptoms
Trade: Pharmacologic: 0.4 mg/hr. Wear Syncope of an acute angina attack. If that occurs, teach George
Nitro-Dur Nitrates patch 12-14 Blurred vision nitroglycerin protocol.
hr/day and take Abdominal pain 2. Educate George on the importance of rotating
Pg. 939 DDG *Produces off for 10-12 Nausea transdermal patch sites and to take it off as directed by
vasodilation and hr/day. Vomiting physician. Also inform George that patients can develop
increases coronary Dizziness a tolerance to nitroglycerin, and it is crucial to follow
blood flow by dilating Headache when the transdermal patch needs to be removed.
coronary arteries and Apprehension 3. Teach George how to avoid orthostatic hypotension and
encouraging collateral Restlessness the signs and symptoms of this.
flow to ischemic Weakness
regions. * Alcohol intoxication

References:

Vallerand, A. H., & Sanoski, C. A. (2023). Davis’s drug guide for Nurses (18th ed.) F.A. Davis

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. M. (2023). Medical-surgical nursing in Canada:
Assessment and management of clinical problems. (5 th Canadian ed.). Elsevier.

Potter, P., Perry, A., Stockert, P., Hall, A., Astle, B., & Duggleby, W. (2024). Canadian fundamentals of nursing (7 th ed.). Elsevier

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Visovsky, C. G., Zambroski, C. H., & Hosler, S. (2022). Introduction to clinical pharmacology (10th ed.). Elsevier.

Supporting indigenous culture in Ontario’s long. (n.d.). https://the-ria.ca/wp-content/uploads/2018/10/Supporting-Indigenous-Culture-

in-LTCH-Report-Final-March-31-2017_updated_A.pdf

Aboriginal Patient Navigator Information (IHA): https://www.interiorhealth.ca/sites/default/files/2021-11/APN%20Brochure.pdf

Social Workers and Indigenous Services: https://bccsw.ca/wp-content/uploads/2019/06/5.0-Indigenous-Committee_Terms-of-

Reference.pdf

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